How to Prepare for Flu and COVID Season When You Have Type 2 Diabetes

“People with diabetes are at higher risk of infections and complications from viral illnesses due to a reduced immune system,” says Alex McDonald, MD, a family medicine physician at Kaiser Permanente Fontana Medical Center in California. “And the higher the blood sugar, the weaker the immune system,” he says.

Taking proactive steps to prepare for the season ahead is the best way to protect yourself from common winter illnesses like colds, influenza, COVID-19, and respiratory syncytial virus (RSV).

• COVID-19 
• Flu (influenza)
• Pneumococcal disease
• RSV

It’s important to avoid contact with sick people as much as possible, and wear a mask if appropriate or ask others to wear one, says Dr. McDonald. Respiratory viruses, including flu, the COVID-19 virus, and RSV, commonly spread via infectious droplets that are released when a sick person coughs, sneezes, or speaks. This makes physical distance and barriers critical to reducing your exposure.

Make sure you have the following:

• Glucose meter
• Continuous glucose monitor (CGM) supplies
• Ketone test strips
• Glucose tabs or gels
• Diabetes medications you need, like insulin
• Cold or flu medications that are safe for your blood sugar

On the flip side, if you have a poor appetite or are vomiting or have diarrhea, you could swing the other way toward hypoglycemia, says Isabella. “It’s a delicate balance, which is why monitoring your blood sugar closely is so important when you’re not feeling well,” she says.

Isabella advises testing your blood sugar every two to four hours and recording the results. You can then use this log to talk to your healthcare provider about potential changes to food, fluids, and medications to help stabilize your blood glucose.

You may need to make adjustments to your diabetes medications when you’re ill. If you have the opportunity to talk to your doctor before you’re sick, you can develop a plan for how to best handle sick days. Having this plan ready to go means you know what to do if (and when) you get sick, says McDonald. “Talk with your doctor and develop a game plan for what’s right for you, including medication adjustments or changes to better manage your type 2 diabetes,” he says.

Your doctor may suggest adjusting your insulin dosage, but Isabella says you shouldn’t stop taking long-acting insulin; your body uses it to manage higher blood sugar levels during illness. Meanwhile, it may be okay to pause your use of oral diabetes medications like metformin, SGLT2 inhibitors, and GLP-1 agonists under medical guidance and supervision, she says.

Never stop or change your medication regimen without first talking to your prescriber.

Typically, you can treat yourself at home when you have a viral illness. With adequate rest, plenty of fluids, a careful eye on your blood sugar, and other “stay comfortable” care, your body can fight it off and you’ll start to feel better.

However, sometimes you may need medical help. That decision will be much easier to make if you’ve already discussed with your doctor which symptoms require professional evaluation.

“Patients should contact their doctor or come in to be seen in person if they have fever, vomiting, diarrhea, persistent elevated blood sugars, or muscle aches, or if symptoms last more than five days or if symptoms start to improve and then worsen again,” says McDonald.

If you take a turn for the worse, McDonald advises calling 911 or going to the emergency room if you:

• Have uncontrolled fever
• Have uncontrolled vomiting or diarrhea
• Cannot maintain fluid intake
• Have severe symptoms, such as shortness of breath, chest pain, confusion, or extreme weakness

• Individuals with type 2 diabetes face a higher risk of severe respiratory infections due to a weakened immune system, making it crucial to stay up to date on all recommended vaccinations.
• It can also be helpful to prepare a “sick day kit” ahead of cold and flu season, stocking up on blood sugar monitoring supplies, emergency glucose, over-the-counter medications, and easy-to-digest pantry staples.
• During illness, test your blood sugar frequently (every two to four hours), and follow a sick day plan created with your doctor regarding medication adjustments and when to call for professional help.